Maryland Could Adjust State Insurance Plan to Meet Mammography Guidelines

Maryland may update its state-provided insurance plan to reduce coverage for mammograms, based on new and controversial recommendations released by a federal panel last week.

The Maryland Health Insurance Plan, which covers high-risk individuals unable to get health insurance from other sources, usually follows the recommendations by the U.S. Preventive Services Task Force, said Rex Cowdry, executive director of the Maryland Health Care Commission.

The task force last week recommended that women should have routine mammography every two years starting at age 50 instead of having it yearly at age 40. In a report published last week in the medical journal, "Annals of Internal Medicine," the USPSTF also recommended against teaching women self-breast examination, citing anxiety and unnecessary tests and treatments caused by false alarms.

The task force, a division of the Department of Health and Human Services, is an independent panel of experts in primary care and prevention, but does not include any breast surgeons or oncologists. The recommendations, which came amid the health care debate in Congress, have led to speculation that the government and the insurance companies might stop covering the preventive service.

Cowdry said changes to the state plan, if any, won't be effective until July 1.

"Nothing is likely to change rapidly," Cowdry said, because to make a change involves "the most complicated process."

However, the guidelines could affect future policies, he said.

"If we are going to spend 16 percent of the GDP wisely, we will have to follow where the evidence leads," Cowdry said, referring to the nation's health care spending.

Any discussion on the coverage issue will be "heated," Cowdry predicted.

The guidelines will not affect Medicare coverage, Health and Human Services Secretary Kathleen Sebelius assured concerned women in a statement last week.

"There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration, but our policies remain unchanged," she said.

"Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action," Sebelius added.

Private insurance providers in Maryland, including Kaiser Permanente and Aetna, said that no changes, based on the new recommendations, would be made "at this time."

"A decision about mammography requires a detailed discussion between the patient and her physician and it should consider the medical evidence, patient preferences and unique clinical issues for each patient," said Debora Spano, UnitedHealthcare regional spokeswoman. "Mammography coverage at UnitedHealthcare has always been based on this philosophy."

CareFirst follows the American Cancer Society guidelines that continue to recommend routine mammograms starting at age 40, said Dr. Daniel Winn, vice president and senior medical director.

The new recommendations have also led to confusion and anxiety among women.

"The best thing to do is find the cancer early," said 60-year-old Bethesda resident Holly Joseph."That's what we have known all along and this recommendation goes against it."

The American Cancer Society reports that more than 3,600 Maryland women are expected to be diagnosed with breast cancer in 2009.